CASE FILES CLAIM DECADE OF NEGLECT


BACKGROUND A 42-year-old woman – Mrs T – attends a dental surgery as a new patient and is examined by Mr P. The dentist notes that Mrs T is suffering from gross periodontal disease with numerous mobile teeth. The patient is referred to the periodontal department at the local dental hospital where she is examined and a report sent to Mr P. The report indicates aggressive


periodontitis in 15 teeth, with pockets greater than 6mm and generalised bone loss of 60 to 80 per cent. Almost all the teeth show varying degrees of mobility and the consultant recommends a treatment plan involving the extraction of seven teeth and the fitting of a partial upper denture. Mr P carries out the treatment over a series of appointments. Questions then arise over Mrs T’s


previous dental treatment and it transpires she had been under the care of another dentist – Mr F – for the last 10 years. Mrs T first attended the dentist for treatment of caries in an upper molar and was referred to a hygienist for “perio pocketing” and poor oral hygiene. A pocket chart was taken and oral hygiene instruction provided to Mrs T but compliance was poor. Over the next few years Mrs T attended Mr F for routine scale and polish and examinations, in which over time her deteriorating periodontal condition was noted along with


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attempts to encourage better oral hygiene, though with little success. Bitewing radiographs were taken on two


occasions over the period showing increased generalised bone loss. Mrs T suffered with bleeding gums and lost interdental papilla. Scaling and root planing were undertaken along with occasional antibiotic therapy and the patient was advised repeatedly of her poor periodontal condition and the importance of proper tooth brushing technique. Her husband eventually insisted that Mrs T consult Mr P for a second opinion. A letter of claim is later received by Mr F


alleging clinical negligence in his failure to diagnose periodontal disease over the 10-year period Mrs T was in his care. In particular he did not carry out BPE examinations and it is alleged he failed to act on radiographic evidence of the patient’s deteriorating periodontal condition. It is also alleged that the dentist did not undertake systematic deep scaling and root planing, nor did he refer the patient for specialist treatment. Mrs T also claims that the dentist failed to inform her of the condition and the serious implications of her poor oral hygiene.


ANALYSIS/OUTCOME MDDUS instructs an expert to report on the case and she is first critical of the lack of any recorded BPE screening in the


records, though there is reference to pocket charting by the hygienist. The record does reflect discussion of Mrs T’s poor periodontal condition and the need for improved oral hygiene so it is unlikely that the patient was unaware of her condition. The expert is of the opinion that referral to a specialist was indicated, especially when the second radiograph confirmed the progressive nature of the patient’s condition. In regard to causation the expert states


that it is not certain if earlier intervention would have prevented or at least delayed Mrs T’s tooth loss but earlier referral to hospital for aggressive therapy might have made a difference. MDDUS lawyers and advisers decide in agreement with Mr F to settle the case .


KEY POINTS ●Ensure that patients understand the serious nature of periodontal disease and the likely outcomes should treatment advice be ignored. ●Record BPE at each routine examination. A visual examination, even if recorded, is insufficient. ● Maintain full records including treatment provided and any lack of compliance.


These studies are summarised versions of actual cases from MDDUS files and are published in Insight to highlight common pitfalls and encourage proactive risk management and best practice. Details have been changed to maintain confidentiality.


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